Chronic medical conditions seeing multiple physicians

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P-Population and problem Geriatric patients (>65) with two or more chronic medical conditions seeing multiple physicians on a regular basis. I-Intervention Creation of a care plan that outlines all physicians, medical conditions, medications taken for each condition and yearly results updated with all changes for every visit and tracked by a case manager within the primary care office and sent out through a connected EMR to all treating physicians.

Reference no: EM133566068

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